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What is a Post-Hospitalist Program: The Newest Medical Specialty

General Medicine The Post-Hospitalist CompanyHealth care is changing rapidly, leaving some traditional facilities scrambling to find solutions that meet the new standards of care being set by Centers for Medicare and Medicaid Services (CMS). While much of the change is seen as positive strides within geriatric health care, many facilities have settled in vastly uninterrupted, inefficient tactics for decades and are now struggling to meet government expectations.

To add to the conundrum, primary care physicians (PCPs) and nurse practitioners (NPs) within elderly care are often overworked and managing patients within multiple locations. This makes achieving new standards of care quite difficult and sometimes overwhelming for PCPs, NPs and supporting staff. In turn, patient care continues suffering.

A Specialized Approach: Post-Hospitalist Programs

A post-hospitalist program is a specialized approach to caring for geriatric, rehabilitation, and chronic care patients in post-hospital and long-term care environments, including long-term acute care hospitals, rehabilitation facilities, skilled nursing facilities, nursing homes, assisted living facilities and other long-term care facilities. General Medicine, The Post-Hospitalist Company’s program collaborates with all professionals to properly care for and manage patients within these facilities. This includes a careful configuration of attending physicians, NPs, medical directors, support staff, billing personnel and health care management.

Rather than managing post-hospital caseloads in addition to having to make daily hospital rounds and/or managing a private practice, post-hospitalist doctors work solely within the specialized facility. This ensures that patients are receiving the level of care that they need and deserve.

What our post-hospitalist program accomplishes:

Our post-hospital program is dedicated to providing quality care to each and every patient, while creating a conducive working environment for medical professionals.

Since our start, our post-hospitalist program has focused on four important problems within post-acute care facilities:

  1. Lower hospital readmission rates.

Unnecessarily high hospital readmission rates and patient rebounds to the hospital have plagued the industry for decades. It has become so costly and detrimental to care that new penalties on discharging hospitals have been implemented through the Affordable Care Act. While these penalties do not currently impact post-hospital facilities directly, CMS is expected to target readmission rates from these facilities starting in 2017. At that time, CMS will implement direct financial penalties to post-hospital facilities.

Currently, these penalties are problematic for Managed Care Organizations (MCOs), Accountable Care Organizations (ACOs) and PCPs that work with both hospitals and post-hospital organizations. For 2015, more than 2,600 hospitals were penalized as much as 3% of CMS reimbursements for high readmission rates.

The lack of proactive transitional care and barriers in physician communication contributed to this problem. We at General Medicine have worked to eliminate this concern in our partner facilities. The 2013 Quality and Resource Use Report (QRUR), compiled by CMS, found our readmission rates to be 4.8%. With the national average within this peer group at 16.4%, this amounts to a 70% reduction in readmissions for facilities partnered with General Medicine.

Not only does treating on-site create less anxiety and confusion for frail elderly patients, but it also eliminates unnecessary spending. Additionally, transportation trauma is no longer a concern, and patients can remain in a comfortable, familiar setting while getting the care they deserve from a staff they’ve come to trust.

  1. Improve care quality metrics.Post-Hospital Elderly Care

Patient care should be the primary focus of each and every provider and facility within health care. Unfortunately, this has become out shadowed at many locations by decreased reimbursement, the desire to increase revenue, attempting to care for too many patients and limited staff resources.

We work to eliminate those issues in every facility we partner with. Our physicians and NPs work exclusively within the post-hospital environment. This means they are more accessible to facility nursing and support staff and become a more viable resource within proactive patient care. Caseloads for clinicians under a post-hospitalist program are typically between 150 and 200 patients—depending on patient acuity—which are as much as 80% less than traditional practice models.

When comparing services relevant to those performed within our facilities, our post-hospitalist partners maintain quality metrics 48.4% higher than those within our peer group, according to the QRUR.

  1. Increase efficiency of health care spending.

Proactive planning and accessible clinicians ensure that patients receive the most up-to-date standards of care, such as optimal transitional care, the right medications, services and procedures for patients residing in post-acute facilities. Our teams eliminate unnecessary transportation costs and antiquated, costly care methods.

Our post-hospitalists program generally initiates a patient assessment within 24 hours of admissions, or less. This ensures that a coordinated care transition from the hospital occurs quickly and efficiently. From there, a proactive care plan is identified and the patient is monitored appropriately. Our medical professionals work with a preventative medicine mentality, rather than simply reactive. This ensures only medically necessary testing and procedures are done, saving money for facilities and families and decreasing stress for patients.

  1. Maintain wholesome work environments

Employing a happy, fulfilled, consistent group of medical professionals within post-acute facilities is essential to gain the trust and knowledge necessary to care for patients. These patients often live within these facilities for a substantial amount of time, and it becomes difficult for them to trust the medical staff when employee turnover rates are high.

The physicians, NPs and support staff that collaborate together within our post-hospitalist program have a long-term commitment to improving health care within these specialized environments. Our turnover rate has remained consistently low since our start. In fact, many of our clinicians have been with our group for more than a decade.

The unfortunate reality, however, is that this type of employee consistency is not normal behavior within post-acute facilities. In fact, “the median turnover rate for all employees in America’s skilled nursing care centers was 43.9 percent,” according to a report released in 2014 by the American Health Care Association.

At General Medicine, we seek to professionally fulfil each individual we work with by providing education through training sessions, conferences and more. This keeps medical professionals in tune to new standards of care, new technology, new medical procedures, updates in medical billing and more—allowing them to continuously improve their skill sets and the care they provide to patients.

More than 30 years of improved patient care

Shortcomings within geriatric health care are receiving increased publicity due to the Affordable Care Act and IMPACT. These new government mandates highlight necessary improvements in standards of care, readmission rates, health care spending and more.

Long before these initiatives began, Thomas M. Prose, MD, MPH, MBA recognized change needed within elderly care, and with that General Medicine, The Post-Hospitalist Company, was created. Though new standards have challenged much of the industry, Dr. Prose welcomes the change as it further expands the reach of improved care.

General Medicine’s various partners

We partner with an array of organizations and facilities, including MCOs, ACOs and various state healthcare agencies as well as individual post-hospital facilities and management groups. This array of partnerships allows our team to understand the facets within each aspect of the health care industry, and handle each appropriately. No matter which partnership relationship is initiated, the beginning of our process remains the same: identify shortcomings at the facility and identify efficient solutions.

Are you seeking ways to improve patient care at your facility? Partner with General Medicine, The Post-Hospitalist Company to get the help you need and the care your patients deserve.

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Tom Prose